PT  - JOURNAL ARTICLE
AU  - Scotland, G S
AU  - McNamee, P
AU  - Philip, S
AU  - Fleming, A D
AU  - Goatman, K A
AU  - Prescott, G J
AU  - Fonseca, S
AU  - Sharp, P F
AU  - Olson, J A
TI  - Cost-effectiveness of implementing automated grading within the national screening programme for diabetic retinopathy in Scotland
AID  - 10.1136/bjo.2007.120972
DP  - 2007 Nov 01
TA  - British Journal of Ophthalmology
PG  - 1518--1523
VI  - 91
IP  - 11
4099  - http://bjo.bmj.com/content/91/11/1518.short
4100  - http://bjo.bmj.com/content/91/11/1518.full
SO  - Br J Ophthalmol2007 Nov 01; 91
AB  - Aims: National screening programmes for diabetic retinopathy using digital photography and multi-level manual grading systems are currently being implemented in the UK. Here, we assess the cost-effectiveness of replacing first level manual grading in the National Screening Programme in Scotland with an automated system developed to assess image quality and detect the presence of any retinopathy.Methods: A decision tree model was developed and populated using sensitivity/specificity and cost data based on a study of 6722 patients in the Grampian region. Costs to the NHS, and the number of appropriate screening outcomes and true referable cases detected in 1 year were assessed.Results: For the diabetic population of Scotland (approximately 160 000), with prevalence of referable retinopathy at 4% (6400 true cases), the automated strategy would be expected to identify 5560 cases (86.9%) and the manual strategy 5610 cases (87.7%). However, the automated system led to savings in grading and quality assurance costs to the NHS of £201 600 per year. The additional cost per additional referable case detected (manual vs automated) totalled £4088 and the additional cost per additional appropriate screening outcome (manual vs automated) was £1990.Conclusions: Given that automated grading is less costly and of similar effectiveness, it is likely to be considered a cost-effective alternative to manual grading.